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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant <br />J cp cL <br />(Name) <br />N? 877 <br />PAID3;&- <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />ISAkc$ 75,20 :1KCQ L MO .t„i: <UlIIc_ `mot -G ?cx <br />(Address) (Phone) <br />Owner - " `co �� .. 1 cct- v�;C:.., C I IL}e; ` 1,7;n <br />(Phone) <br />(Name) (Address) <br />Property Location (Street Address and Legal Description): <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />.sec A4. Lai -.r <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ing and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />in the application procedures and hereby agree to' avail statements received from the City pertaining to additional applica- <br />tion expense. <br />)(/ <br />Page 56 ,//'% '�, <br />WHITE — Office CANARY — Customer PINK —Pile GO LO•Planner <br />Applicant)! / '(Date) <br />